What does “futility” mean? An empirical study of doctors’ perceptions

White, Benjamin P., Willmott, Lindy, Close, Eliana, Shepherd, Nicole, Gallois, Cindy, Parker, Malcolm, Winch, Sarah, Graves, Nicholas, & Callaway, Leonie (2016) What does “futility” mean? An empirical study of doctors’ perceptions. Medical Journal of Australia, 204(8), 318.e1-318.e5.

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Abstract

Objective(s)

To describe how doctors define and use the terms “futility” and “futile treatment” in end-of-life care.

Design, Setting, Participants

A qualitative study using semi-structured interviews with 96 doctors across a range of specialties who treat adults at the end of life. Doctors were recruited from three large Australian teaching hospitals and were interviewed from May to July 2013.

Results

Doctors’ conceptions of futility focused on the quality and chance of patient benefit. Aspects of benefit included physiological effect, weighing benefits and burdens, and quantity and quality of life. Quality and length of life were linked, but many doctors discussed instances when benefit was determined by quality of life alone. Most doctors described the assessment of chance of success in achieving patient benefit as a subjective exercise. Despite a broad conceptual consensus about what futility means, doctors noted variability in how the concept was applied in clinical decision-making. Over half the doctors also identified treatment that is futile but nevertheless justified, such as short-term treatment as part of supporting the family of a dying person.

Conclusions

There is an overwhelming preference for a qualitative approach to assessing futility, which brings with it variation in clinical decision-making. “Patient benefit” is at the heart of doctors’ definitions of futility. Determining patient benefit requires discussions with patients and families about their values and goals as well as the burdens and benefits of further treatment.

Impact and interest:

2 citations in Scopus
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1 citations in Web of Science®

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ID Code: 95491
Item Type: Journal Article
Refereed: Yes
Keywords: Futile treatment, Futility, End of life decision-making, Withholding and withdrawing life-sustaining treatment, Doctors' perceptions
DOI: 10.5694/mja15.01103
ISSN: 1326-5377
Subjects: Australian and New Zealand Standard Research Classification > PHILOSOPHY AND RELIGIOUS STUDIES (220000) > APPLIED ETHICS (220100) > Bioethics (human and animal) (220101)
Australian and New Zealand Standard Research Classification > PHILOSOPHY AND RELIGIOUS STUDIES (220000) > APPLIED ETHICS (220100) > Medical Ethics (220106)
Divisions: Current > QUT Faculties and Divisions > Faculty of Health
Current > QUT Faculties and Divisions > Faculty of Law
Current > Research Centres > Australian Centre for Health Law Research
Current > Institutes > Institute of Health and Biomedical Innovation
Current > Schools > School of Law
Current > Schools > School of Public Health & Social Work
Funding:
Copyright Owner: Copyright 2016 Australasian Medical Publishing Company Ltd
Deposited On: 11 May 2016 23:44
Last Modified: 13 May 2016 15:24

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